Life of the Mind
Economics: Mortality Rising

Professors Anne Case *88 and Angus Deaton say rising suicide rates and drug and alcohol use have taken a toll on middle-aged American whites.

Sameer A. Khan

Case-Deaton study reveals a sharp rise in death rates for middle-aged whites Americans

A study by professors Anne Case *88 and Angus Deaton captured headlines for days — even attracting the attention of President Barack Obama — for its startling finding of a steep rise in death rates for middle-aged American whites.

Mortality rates for middle-aged whites of both sexes rose by half a percent each year between 1999 and 2013, the study found, in sharp contrast to mortality rates for Americans of other ages and in other racial groups, which fell. The rise was particularly stark among middle-aged whites without a college degree. If rates had continued to decline at their historical levels before 1998, the study estimated that half a million deaths might have been avoided.

Both Case and Deaton are jointly appointed in the economics department and the Woodrow Wilson School, and also are married. Deaton received the 2015 Nobel Prize in economics.

The report, published in the Proceedings of the National Academy of Sciences in November, suggests that the increase in mortality rates is not related to a growing number of deaths from cancer or chronic diseases such as diabetes and heart disease. Rather, it corresponds with a sharp rise in suicides, drug and alcohol poisoning, and cirrhosis of the liver. It also coincides with a dramatic increase in the use of strong painkillers and other opioid drugs, such as Vicodin and OxyContin, as well as a renewed heroin epidemic, much of it in rural parts of the country, affecting more whites, middle-aged people, and women than in previous epidemics.

“The opioid problem has got to be reined in,” Case says, “and the rise in suicide rates has to be addressed by the mental-health community and the people who fund it.”

Although social scientists and demographers have been writing for some time about the obstacles faced by working-class Americans due to the loss of manufacturing jobs and stagnating wage rates, the study provided surprising evidence of how serious the problem is.

The authors stumbled on the findings while studying government statistics on death rates and illness, and initially were skeptical that the figures were as bad as they appeared. “We both were sort of blown off our chairs when looking at that,” Deaton told The Washington Post.

Obama buttonholed the authors at a White House reception for American Nobel laureates shortly after the study was published. “We weren’t even through the door before he said, ‘Thank you for this work. This is really important,’” Case recalls.

Two medical journals previously had rejected the study. The New England Journal of Medicine, Case says, declined to publish the piece because while it identifies factors — such as suicides — driving the increased mortality rate, it did not explain what is causing those factors to rise, which she compared to the fire department refusing to answer a call until the homeowner could say what had caused the fire.

The attention that the findings garnered led to a discussion in the media of the sexist treatment sometimes experienced by women economists. Although Case is the lead author of the study, Deaton’s name frequently was listed first in press accounts. “I think women are often not heard, or are given second-billing, by both men and women,” Case says. “Does that concern me? Of course it does.”